Institutional Contradiction and Hospital Social Work Practice in China: Professionalization As a New Impetus

Background and Purposes: The development of social work in China over the past several decades has presented a unique trajectory which has attracted much attention from academics internationally. While research usually attributes China’s unique case to its distinctive institutional and cultural contexts such as the powerful government and Confucianism, little scholarly efforts have been devoted to understanding the complexity of the external environment resulted from unprecedented social transformation of China.

This study aims to bridge the research gap by investigating the impacts of the institutional contradiction on social work practice in the hospital setting. The study focuses on how social work practitioners in a rehabilitation hospital perceive, behave and develop new knowledge in response to the changing external environment amidst service delivery. This study is expected to have important implications for the development of social work profession in China.

Methods: A qualitative study was conducted with 21 participants in the Socio-vocational Rehabilitation Department (thereafter SRD) in a rehabilitation hospital in Beijing including nine social workers, three doctors, three nurses, four managers, and two officials. Semi-structured interview guides were used. With the agreement of the participants, some interviews were taped and transcribed afterward. All qualitative data, including transcripts, ethnographic notes, and bibliographic data, were systematically coded for subsequent analysis. The researcher adopts a grounded theory approach to data analysis.

Findings: One major finding suggest that the marketisation of the health care system accompanied by a decrease of subsidy from the central government and a stress on compliance to political mandate stipulated by the Chinese government has led to two sets of contradictory requirements upon the social work practice in the hospital. To adapt to such a radical change of institutional environment, the social work practitioners had adopted a hybrid practice approach with a dual emphasis on fulfilling the political requirements of the Communist party as well as the profit making requirement of the newly introduced marketisation health care system. Social work as an emerging profession in China since 1990s has been built upon a set of values and philosophies different from the two aforementioned ideologies. Against this backdrop, the social workers in the hospital have to find ways to address all these contradiction rising from different requirements imposed by the institutions and the larger environment. The emerging social work profession has provided them a promising direction to manage the contradictory institutional environment with some initial success.

Conclusion and Implications: The co-existence of the political and market requirement is unique to the health care sector in China. This paper presents the way by which social workers have developed a hybrid approach to address incompatible policy contradictions. The professionalization of social work in recent decades has offered a new impetus for social workers in practice to resist institutional pressures and resolve the conflicting policy imperatives. This study could be improved by including more social work practice cases and quantitative data evidence for deeper understanding of the development of social work in China.